Taking Healthcare by Storm: Industry Insights with Jillian Pate & Natalie Tappe

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Jillian Pate, MS, RD, CSR, LD, a Renal Dietitian Nutritionist, and Natalie Tappe, MSN, RN, a Quality Improvement Specialist at Quality Insights.

Visit the West Virginia Chronic Kidney Disease (CKD) webpage.
Contact Jillian.
Contact Natalie.

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-GEN-080924-GK

Transcript

Welcome to Taking Healthcare by Storm, industry Insights, the podcast that delves into the captivating intersection of innovation, science, compassion, and care.

In each episode, Quality Insights Medical Director, Dr.

Jean Storm, will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys.

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania, and the nation.

Subscribe now, and together, we can take healthcare by storm.

Hello, everyone, and welcome to another episode of Taking Healthcare by Storm.

I am Dr.

Jean Storm.

I am the Medical Director of Quality Insights.

And today we're talking about another one of my favorite topics, Chronic Kidney Disease, something that I have been, I'm gonna say best friends with for a very long time, because I'm an Internal Medicine Doctor in Primary Care, and Chronic Kidney Disease is something that we see often.

But today we have a repeat guest.

Jillian Pate is with us, and she is a renal dietician.

And I will say, I learned things about CKD prevention that I did not know before during our first podcast.

And we are joined by Natalie Tappe as well.

And she is a Quality Improvement Specialist, and she works in all things chronic disease at Quality Insights and does just a fantastic job in teaching individuals how to manage their chronic diseases.

She does a lot of education.

So we're gonna be talking about chronic kidney disease, especially in West Virginia.

And then we're gonna be talking about a special program aimed at preventing the progression of chronic kidney disease in West Virginia.

So Jillian, welcome back.

Natalie, welcome.

Thank you.

So Jillian, let's start.

Tell us, just give us a refresher about what you do and how you arrived at what you're doing now.

Yeah.

So like you mentioned, I am a renal dietician.

I am one of the two renal dieticians actually here in West Virginia.

I've actually been a registered dietician for the last 10 years.

I'm from West Virginia, so I'm from this area.

And so I quickly fell in love with helping individuals that are here locally.

And about eight years ago, I decided to start working in the dialysis setting where I was meeting a lot of individuals with in-stage renal disease.

And then I quickly realized how preventative nutrition was not a part of their journey prior to starting dialysis.

So I dug a little deeper, did some more research, ended up going and sitting for my boards once again to get renal certified so I could bring my knowledge and the ability to just provide more education for the residents here in West Virginia, just to really show them that we can still kind of halt further progression with their chronic kidney disease.

Yeah, it is such an important issue and I feel like it's just kind of coming into its own.

So Natalie, I know you, but can you tell our listeners who may not know you, tell us, tell them what you do and how you arrived at doing what you do.

Okay.

I am a quality improvement specialist.

For Quality Insights, I've been at Quality Insights for 15 years.

And our goal as a quality improvement organization, basically, is to provide or increase the quality of healthcare that we deliver to patients, primarily Medicare and Medicaid, but to all people in West Virginia.

By working with Medicare, we can definitely help improve health care quality.

So how I arrived here, basically, was introduced to Jillian from Brandy Vinson, Quality Insights Executive Director of Renal Network 5.

She thought that perhaps we could get together and maybe work on CKD in West Virginia since it's such a problem.

So we set up a meeting and Jillian discussed the need for the CKD prevention program.

And then with the help of Bethany Hall, Quality Insights Director of Strategic Relationships, we were able to submit a proposal to the Benetton Foundation.

And once they liked the idea of helping individuals with chronic kidney disease, we applied for the grant and we were approved for the grant in January of 2024.

So from there, we, I will let Jillian or you take it, and she can explain exactly what we do and how we impact those in West Virginia with chronic kidney disease.

Okay.

I think maybe we should kind of, let's talk about CKD in case individuals out there in the audience aren't aware.

So, Jillian, can you give us an idea of how big an issue CKD is in West Virginia?

Yeah.

So, you know, CKD, it comes in different stages.

But the biggest thing about chronic kidney disease is that it's most prevalent with those that have a history of like hypertension, diabetes.

Those tend to be the common cause of why someone would end up with CKD.

And so, honestly, the most recent surveys and things like that data collection that we have is from 2022.

And it pretty much just reflects that about almost 5% of West Virginia residents have chronic kidney disease.

And even though 5%, 4.9, you know, it doesn't look like very much, but when you actually look at the amount of residents that we had in West Virginia at that time, it reflected about 81,000 West Virginia residents with just that noted CKD.

This isn't even including those that might not have even been tested for it yet.

Yeah, I think that that's, you know, underestimate.

And I think there's a lot more people at risk of developing CKD.

Absolutely.

So Natalie, why do you think CKD is such a big problem in West Virginia?

One of the things is the socioeconomic factor or social determinants of health.

It's hard when you live in a rural area to access health care and healthy lifestyle changes or options.

It's difficult when you try, and Jillian knows this, as a dietician to tell somebody to eat fresh fruits and vegetables when they don't have the ability, A, to pay for it, or B, to get to a grocery store that sells those healthy items.

So socioeconomic factors, access to health care.

Also, unfortunately, in West Virginia, and I'm sure Jillian will agree, is a lot of times poor diet.

We don't exercise a lot, and we smoke a lot in West Virginia.

So these may not only contribute to CKD, but other chronic illnesses.

And it's also, you know, I don't think that the healthcare in general doesn't really educate those that may be able to stop the progression of CKD or worsening of CKD.

Sometimes I feel like we really need to dig our heels in and approach providers, hospitals, clinics, federally qualified health centers, et cetera, to really promote CKD prevention, because it really is not something that you want to have.

No one wants to end up on dialysis.

So I think that it definitely is more important for us to get out there, boots on the ground, if you will, to address those needs and see what we can do to help the people in West Virginia.

I would agree.

And I think it's like a silent, I don't want to say a silent killer, but CMS has this idea, they're trying to prevent people from crashing into dialysis.

Yeah, they don't know.

So I love the term medical nutrition therapy.

So Jillian, can you tell our audience, what is medical nutrition therapy?

Yes.

So medical nutrition therapy is essentially a way for registered dieticians to be able to provide our essentially our expertise for individuals.

So what we do is whenever we work with someone, we really assess the full situation.

We are looking at their lab work, their past medical history.

We're really taking a good assessment of what we're looking at, because that is one thing about chronic kidney disease.

It truly does look different for each person.

So what might work for you might honestly not work for your neighbor, who might still have almost kind of comparable labs.

So we also, we just, you know, we look at the assessment, we educate them.

And one of the ways that we also educate them is that we make sure that we're using like research-based information.

As much as it would be easier for us to utilize our own opinions about things, we want to make sure that we are giving them sound education, that we're letting them know, you know, this is what we're going to do.

And then medical nutrition therapy as a whole gives us these parameters as far as how much protein to recommend per their stage of kidney disease and, you know, how much sodium fluid, you know, really break it down for them, for them to understand exactly what they can do for their part.

So that way, hopefully, it helps relieve just that overwhelming pressure that they might have when they first find out about a new diagnosis that they had been, you know, told by their provider.

Yeah, it's just so important.

And Natalie told us a little bit about how Quality Insights became involved in the West Virginia CKD Prevention Program with the assistance of the Benadim Foundation.

So can you tell us about what this program is, the West Virginia CKD Prevention Program, and what areas is it operating in?

Yes.

So like Natalie mentioned, this is a huge opportunity for us here in the state to really just get preventative services back into our state.

You know, like I mentioned earlier, you know, we, you know, we have a very high prevalence of those with CKD, and we're actually, and I know this isn't a shocker, but we are the 50th in ranking for those with CKD.

So we have some we have some work to do, but that's okay.

So what we wanted to do is we wanted to create this prevention program and really focus in on some role areas, because we knew if we could focus on these areas and it can work for them, we know that it can apply to anywhere else in the state.

So we focused in on Jackson, Roan, Mingo, Wyoming, Greenbrier and Boone County.

And so what we're doing is we are seeking out referrals.

And any patient that has diabetes, hypertension already maybe have earlier stages of chronic kidney disease, we're just asking for referrals.

And what we're doing is it's a six month program.

And during the six month program, they get the opportunity to work with a dietitian within that for at least four visits.

All of it is telehealth, which I love because it reduces the barrier of transportation.

We also make sure that we cover their services with insurance.

And what we do is we just take it a step at a time.

Sometimes our very first meeting with these individuals is just truly hearing them out, hearing things that they have felt overwhelmed with, their own barriers that might have been there.

And then we just kind of start slowly working towards just progression.

You know, and so it's a great six month program.

And the one thing I love about it is, is that if these individuals still need help after those six months, we are still available.

But we're really kind of focusing in at just six months at a time, just for them to truly see hands on what a difference it can make, just committing to a more healthy diet within that time.

Yeah, it's a tremendous amount of support that's available.

So you talked about telehealth.

So do you think transportation problems prevent patients from accessing preventative services for CKD?

I do.

And you know, I think a lot of times when we think about chronic disease states, we sometimes kind of quickly go to the elder population.

So you know, of course, those that might not be able to transport, you know, appropriately, you have to depend on family members.

That is a huge barrier to, I think, in general, to get to health care settings.

And I think that's why a lot of times we're missing those diagnoses just for transportation in general.

But we also have individuals with chronic kidney disease that are still working.

And for them to have to take off more time off of work to go see one more specialist or one more person that can provide them help, that in itself is a barrier.

So by us being able to provide telehealth, we are flexible.

We work with our individuals to make sure that, you know, hey, we can talk to you after you get off work this day, or we can talk to you on your lunch break.

And it just really helps meet them right where they're at.

I agree.

I mean, that's it.

That's reducing a huge barrier.

I think the other thing people think about, you know, when they think about their insurance, they think about going to the doctor.

Going to, you know, get an imaging study, you know.

So do you think that people think about their insurance?

Do you think people understand that, you know, that insurance is going to cover the services of a renal dietician?

I don't.

I think there's just a lot of communication that could be more clear, if I'm being honest.

Like, I think that if we could just let them know, like, you know, we already, if we have insurance, let's utilize it to the best ability that we can.

And so, insurance does, you know, thankfully, Medicare has really led the mark with this.

So Medicare, you know, will cover 100% of their services.

And a lot of the other insurance companies have followed suit.

So really, by them just giving us a few moments for them just to explain more about our program and what we do, we try to really quickly let them know that they're going to be taken care of and that financial burden, you know, doesn't have to be there.

So important.

So important.

So let's talk about the timeline of the CKD prevention program.

Yes.

So the timeline of it is, and like I mentioned, it's a six-month program.

So what we're pretty much doing is we are starting out.

It's myself and I actually have three other dietitians that are contracted with my business here in the state and they are helping with this program.

And so what we're doing is it's a six-month program.

They start out with getting scheduled.

We provide for them what is called a pre-test survey just to get some basic knowledge of where we're starting at.

And then as we go through the program, we're also submitting weekly check-in surveys.

And so this is the opportunity for us to see what they're meeting for their goals for each week.

And that way, when we follow back up with them, we can really address it more appropriately and just make sure that if there's something that they feel like they're falling behind in their goals, we can catch them back up.

And then at the end of the six-month program, we then resubmit a post-test, which completely mimics the pre-test just to see that growth that they have had in the six months.

That's fantastic.

And it sounds like it's really tailored to each individual.

So when I met with both of you to get an idea of what this program was, you showed me the renal dietitian toolkit.

So can you tell our audience a little bit about this toolkit?

Yes.

So one of my big things for this program that I really wanted to really kind of draw from is I wanted to look at the sustainability.

because if I'm being honest, I love when so many times we can go out and we can start projects and we can start programs and really go in strong with the emphasis of what we're wanting to do.

But after a while, whether the funds may not be there or the emphasis type starts to kind of like laugh a little bit, I want to make sure that there's some sustainability behind this.

And like I said, as a renal dietician, like I said, there's not very many of us in the state.

So my heart is to hopefully help encourage other dieticians to become a renal dietician as well because there is plenty of work to be done.

And so what I wanted to do is I wanted to make sure to provide every dietician that wants to become a renal dietician the opportunity to learn more about the program and how to really break it down, provide their services.

So that way, everything that we are communicating is consistent formatting, and it helps the dieticians also really realize how they can use their knowledge and their expertise in this way.

I love that.

You're not only educating the patient, but you're also educating the renal dieticians who are doing this work.

That's fantastic.

So Natalie, I know you are a master trainer in chronic disease.

Yes, master trainer.

So you know a lot about testing, pretesting, post testing around all things, chronic disease.

So tell us, you know, maybe a patient, Medicare beneficiary doesn't understand why they're taking the test.

So tell us about the importance of the pretest and the post test in this program.

Well, as Jillian mentioned, mostly what we want to find out is what did they learn?

What did the people learn?

What did they learn or what did they know, excuse me, before and what did they learn after?

It tells us especially as the educators and the trainers and the lead trainers, how effective our programs are.

We teach chronic disease self-management as well as diabetes self-management and within those classes, we always address kidney disease.

So if they don't, as Jillian mentioned too, if they don't know that they have kidney disease, one of these questionnaires or these questions may pick that up.

We look at where are the knowledge gaps?

Where are they not learning?

What's lacking in our ability as instructors to teach?

It's very helpful because the post-tests will help us.

Someone may not even like what we're teaching.

They may give us constructive criticism to make the classes shorter, educate more on chronic kidney disease or leave out diabetes or something similar to that.

It helps us by them, the participants evaluating us, we're able to see how much we need to change the training program or perhaps the curriculum or interventions that we're doing.

And it also helps them because we provide feedback to them.

What did they do?

For an example, for our blood pressure clinics, we look at pre and post tests for our blood pressure clinics.

A lot of times people will come up to us and say, well, I had no idea that that would cause hypertension or high blood pressure, or I was unclear about how much salt intake was bad for me.

So once we do the pre and the post test, we're also giving them feedback, something that they may not know and help them understand about chronic kidney disease, about diabetes, about hypertension.

And then this is one of the biggest factors for me, is to motivate people to learn.

because if they see, and this has happened on multiple occasions, if they have seen the improvement in their health by taking our class, then it can motivate them to continue their progress, hopefully for a very long time.

Yeah, I would agree.

It's like teaching, you teach a man to fish.

Agreed?

Right.

Yes.

Yeah.

So Jillian, can anyone get involved in this program?

Yes.

So it's still, like we mentioned, it is West Virginia Chronic Kidney Disease Prevention.

So it is for all of West Virginia.

We obviously are still focusing on those rural counties, just to kind of get the data pulled from those areas.

But anyone that's interested, the need is there.

So we are here to help.

And so if anyone is interested in being a part of it, that's what we're here for.

Excellent.

Natalie, anything else to add?

I just want to say how important it is for referrals to our program.

because without the referrals, we don't get to see the patients.

We have probably three or four Jillian, I believe, nephrologists.

I'll have to clarify with her, but we have contracted or contacted several nephrologists to say, you know, we have this program here, please utilize it.

So it's very important that physicians know about the program and can refer patients.

Also, one of the things that is very important, we're thinking about, since sometimes the first line of the participants knowing about chronic kidney disease is their primary care provider.

So we have printed up posters, if you will, that gently remind physicians, whether it's a nephrologist, whether it's an endocrinologist, whether it's a primary care physician or an internal medicine, hey, we have this program in West Virginia, and the patient or the participant can say, hey, can I enroll in that program?

So we have distributed those posters to people around West Virginia, and we're hoping to increase our enrollment by that way too.

Yeah, super important for nephrologist primary care to understand that this is available.

I agree.

Jillian, any last words to add?

I'll pretty much just tagline what Natalie said, is that like I mentioned, there is a lot of residents here in West Virginia that really could benefit from this program.

So I just want to encourage if you're listening as someone that has chronic kidney disease or someone that helps treat someone with chronic kidney disease, just please just take a moment to just refer them to a renal dietician.

We'll take care of the rest.

We'll make sure to take the best care of you and really help reduce some of the barriers that you might be facing with your kidney disease.

Fantastic.

Natalie, if anyone wants any more information about the program, can they just reach out to you or is there another avenue for contact?

Yeah, they can reach out to me or to Jillian.

Jillian can provide her email address for you.

Excellent.

And we also have our Quality Insights website as well.

I'm sorry.

OK, so what is the Quality Insights website?

So it's qualityinsights.org/wvckd.

Perfect.

So if anyone is interested, we will link that website with the podcast.

Also contact emails for Natalie and Jillian.

If anyone is interested in primary care or patients themselves would like to reach out, please do so.

It can avoid crashing into dialysis.

Natalie and Jillian, thank you so much for joining us today.

Thank you so much.

Thank you for having us.

Bye-bye.

Thank you for tuning in to Taking Healthcare by Storm, industry Insights with Quality Insights Medical Director, Dr.

Jean Storm.

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If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website.

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So until next time, stay curious, stay compassionate, and keep taking healthcare by storm.